Normal Speech and Language Development Heidi M. Feldman MD PhD Ballinger-Swindells Professor Stanford University School of Medicine

Faculty Disclosure Information In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

Role of Pediatrician Screening for delays and disorders in language requires pediatrician to know developmental course and red flags for abnormal/slow progress Evaluation of children with documented delays and disorders requires pediatrician to generate differential diagnosis Support for children and families receiving treatment for developmental delays and disorders requires general concepts re: SL therapy

Learning Objectives Define language, speech, and components Recognize normal development birth to 7 years Discuss the fundamental requirements for language

Communication The activity of conveying, transmitting, exchanging information Uses a common system though not necessarily intentionally Examples A bird’s mating song An infant’s cry A person’s shudder in the cold A child placing a parent’s hand on the door when she wants to leave

Language Complex and distinctly human skill Two defining features Symbolic Rule-governed system Allows people to understand and produce an infinite number of messages Allows communication about non-present, future, abstract, hypothetical Cements social interactions

Speech Usual output of the language system Requires coordination of respiratory and oral motor mechanisms Other outputs of the language system Sign language Written language

Component of Language Expressive versus Receptive skills Phonology: Speech sounds in a language with reference to distribution, patterning, and tacit rules of pronunciation Morpho-syntax: Regularity in grammatical features, such as word order, and internal structures of words, such as prefixes and suffixes that affect meaning Semantics: meaning (literal and figurative) at the levels of words, phrases, sentences, and discourse Pragmatics: social functions of language Using language for different purposes Changing language according to the needs of a listener or situation Following rules for conversations and storytelling

Requirements for Speech Plan and organize respiratory and oral motor mechanism Control breath and muscles Produce speech sounds in isolation and context Regulate voice and resonance Speak fluently

(Expressive & Receptive) Coordinating breath & movements Motor planning, execution Speech sounds Voice & resonance Speech Sounds Fluency SPEECH & LANGUAGE SKILLS (Expressive & Receptive) Obeying rules Phonology Pragmatics Morpho-Syntax Semantics

Language Learning Observational and social learning No direct instruction Biological factors Human brain is self-organizing system Infants pick up statistical properties in speech Infants link speech perception to motor output Environmental factors Children learn language of their environment

Overview: Language Learning Infancy: development of pre-linguistic At 1 year: First words beyond ma-ma and da-da 18-24 months: Slow progress, receptive skills first 24 months: Explosion of vocabulary, grammar 24-48 months: Dramatic growth in vocabulary, grammar 4 - 5 years: mature language skills 7 years: mature speech sounds Over 7 years: Application of language and speech to concepts, reading, and academic skills

Building Blocks at Birth Enter into a quiet alert state Turn to the source of sound Prefer the human voice to other sounds Look at faces Track and follow Prefer faces to other stimuli

Developments in Infancy Age Receptive Expressive 2 – 4 months Statistical patterns Coo 6 months Turns to name Babbles 9 months Verbal routines wave bye-bye Mama, Dada 12 months Early Words First words

Pre-linguistic Behavior

Early Language Video

Observations

Additional Toddler Skills Age Receptive skills Expressive skills 12-15 months Follows 1-step commands with gesture Slow increase in words 15-18 months Simple pronunciation Over or under-generalization

Early Grammar

Observations

More on Early Grammar

Preschoolers Age Receptive skills Expressive skills 30 months Follows 2-step commands Asks what’s that 36 months Asks why 48 months Creates narratives

Preschool Language

Observations

Narrative Discourse

Observations

Early School Age Receptive language Expressive Limited by conceptual and social understanding Limited by attentional capacities Gaps in understanding are subtle Expressive Increasing use of complex structures Immaturities in speech (r, l, w, y, consonant blends)

Later School Age Reading as language-based skill Requires mapping letters (graphemes) to sounds (phonemes) Requires rapid naming Relies on verbal memory Reading highly associated with phonemic awareness (rhyming, word games)

Requirements for Language Learning Functioning Healthy & Normal Intact Adequate Supportive Oral mechanisms Human brain & cognition Hearing Verbal Input Social interactions

Differential Diagnosis of Language Delays or Disorders Low SES, parents with limited education Inadequate, adult-centered Verbal input Abnormal structure or function Genetic or Neurologic Disorders Impaired Un-supportive Cleft palate, velo-pharyngeal insufficiency Cognitive Disability, Neuro, Autism, SLI Sensori-neural hearing loss Child abuse or neglect, orphanage Oral mechanisms Human brain Hearing Social interactions

Summary Language is a uniquely human ability, characterized by symbolic communication A few key milestones allow detection of normal development and developmental delays Language development occurs in the context of social interactions and rich verbal input

Thank you.